Provider Demographics
NPI:1285407197
Name:LTC PSYCHOTHERAPY CORP
Entity type:Organization
Organization Name:LTC PSYCHOTHERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURCHETTA-COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-258-7366
Mailing Address - Street 1:11224 MARINA BAY RD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8362
Mailing Address - Country:US
Mailing Address - Phone:401-258-7366
Mailing Address - Fax:
Practice Address - Street 1:11224 MARINA BAY RD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8362
Practice Address - Country:US
Practice Address - Phone:401-258-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LTC PSYCHOTHERAPY CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty